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Diabetes, vascular disease connection differs by phenotype
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Clear links exist between diabetes and vascular disease but differ depending on vascular phenotype, according to findings published in Diabetes Care.
Researchers at the New York University School of Medicine looked at 3,696,778 self-referred participants in the Life Line Screening vascular survey between 2003 and 2008 at more than 20,000 sites representing a broad geographic and socioeconomic spectrum.
Binita Shah, MD, of the division of cardiology, and colleagues examined questionnaires detailing demographics and clinical risk factors and investigated the relationship between diabetes and phenotypes of peripheral vascular disease: lower extremity peripheral arterial disease (PAD); carotid artery stenosis (CAS); and abdominal aortic aneurysm (AAA). The researchers evaluated prevalence, with PAD defined as ankle-brachial pressure index <0.9 or prior revascularization, CAS as ≥50% stenosis or prior revascularization and AAA as infrarenal aortic diameter ≥3 cm or prior repair.
Diabetes was present in 10.8% of participants (n=399,884). Prevalence of PAD, CAS and AAA was significantly higher (P<.0001) in participants with diabetes relative to those without. After adjustment for demographics and risk factors, a significant interaction was seen between diabetes and vascular disease phenotype (P<.0001). Diabetes was associated with increased odds of PAD (OR=1.42; 95% CI, 1.41-1.4) and CAS (OR=1.45; 95% CI, 1.43-1.47), but decreased odds of AAA (OR=0.86; 95% CI, 0.84-0.88).
“The strength of association was more pronounced with increasing severity of disease in each of the three vascular phenotypes,” the researchers wrote.
The positive association with PAD and CAS and the negative association with AAA remained strong in participants with asymptomatic disease. The associations were similar in women and men, but lower odds of AAA were only seen in men, warranting further exploration.
“Future studies exploring the mechanism for these vascular-specific differences are needed,” the researchers wrote.
Disclosure: The research was partially funded by NIH/NHLBI grants and by a Doris Duke Clinical Scientist Award.
Perspective
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Odelia Cooper, MD
Prior published studies have focused on singular vascular complications while Shah’s multi-state study is novel in analyzing all 3 vascular complications, their symptoms and severity in concert within the same cohort, while adjusting for other cardiovascular risk factors. The authors’ findings confirm current thinking and provide additional support to consider PAD and CAS screening in asymptomatic patients. USPSTF guidelines suggest AAA screening in non-smoking men aged 65-75 years with affected first-degree relatives. Interestingly, Shah’s study, which adjusts for tobacco use, shows that diabetic men, unlike women, are protected from AAA risk. There are a few limitations to this study including relying on self report of diabetes and not accounting for duration, severity (ie. glycated hemoglobin), and type of DM, nor presence of pre-diabetes. Despite these caveats, the study does heighten awareness of PAD and CAS, thereby encouraging clinicians to consider screening in asymptomatic diabetic patients.
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